Climate change is the biggest threat to humanity through compounding ecological disasters. A focus on global averages tends to hide dramatic differences and mask health disparities that exist for Indigenous people. For 21 years, district health boards (DHBs) were responsible for providing or funding the provision of health services across Aotearoa. The introduction of the Pae Ora (Healthy Futures) Act 2022 disestablished DHBs and offered an opportunity to reshape health in ways that give serious consideration to climate change impacts. The need to give greater consideration to Indigenous people in climate change conversations is essential.

This systematic review centres planning, policy and/or strategic developments and implementation of climate change adaptation with Indigenous groups in Australia, Pacific Islands, Canada and the United States. We used PRISMA protocols to search five databases. The search was organised around three core areas: Indigenous people groups, climate change strategic planning, and Indigenous knowledge and active participation. A total of 6,338 articles from five databases were identified. Records were screened by title and abstract, leaving 87 articles that were assessed by full text. A total of 22 studies were included.